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The Creation of Standard-Setting Videos to Support Faculty Observations of Learner Performance and Entrustment
Sharon Calaman1, Jennifer H Hepps, Zia Bismilla
1S. Calaman is associate professor, Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania. J.H. Hepps is assistant professor, Department of Pediatrics, Uniformed Health Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland. Z. Bismilla is assistant professor, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada. C. Carraccio is vice president for competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina. R. Englander is senior director for competency-based learning and assessment, Association of American Medical Colleges, Washington, DC. A. Feraco is clinical fellow in pediatric hematology/oncology, Dana Farber and Boston Children's Hospital Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts. C.P. Landrigan is associate professor, Department of Medicine and Pediatrics, Harvard Medical School, and Department of Medicine, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts. J.O. Lopreiato is professor, Department of Pediatrics, Uniformed Health Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland. T.C. Sectish is professor of pediatrics, Harvard Medical School, and Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. A.J. Starmer is staff physician and lecturer in pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, and volunteer affiliate professor, Department of Pediatrics, Oregon Health and Science University (OHSU) and OHSU Doernbecher Children's Hospital, Portland, Oregon. C.E. Yu is associate professor, Department of Pediatrics, Uniformed Health Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland. N.D. Spect
Abstract:
Entrustable professional activities (EPAs) provide a framework to standardize medical education outcomes and advance competency-based assessment. Direct observation of performance plays a central role in entrustment decisions; however, data obtained from these observations are often insufficient to draw valid high-stakes conclusions. One approach to enhancing the reliability and validity of these assessments is to create videos that establish performance standards to train faculty observers. Little is known about how to create videos that can serve as standards for assessment of EPAs.The authors report their experience developing videos that represent five levels of performance for an EPA for patient handoffs. The authors describe a process that begins with mapping the EPA to the critical competencies needed to make an entrustment decision. Each competency is then defined by five milestones (behavioral descriptors of performance at five advancing levels). Integration of the milestones at each level across competencies enabled the creation of clinical vignettes that were converted into video scripts and ultimately videos. Each video represented a performance standard from novice to expert. The process included multiple assessments by experts to guide iterative improvements, provide evidence of content validity, and ensure that the authors successfully translated behavioral descriptions and vignettes into videos that represented the intended performance level for a learner. The steps outlined are generalizable to other EPAs, serving as a guide for others to develop videos to train faculty. This process provides the level of content validity evidence necessary to support using videos as standards for high-stakes entrustment decisions.
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